Acupuncture in Medicine最新文献

Objective: The aim of this study was to investigate the role of ferroptosis in the occurrence of postoperative cognitive dysfunction (POCD) using a mouse model and to elucidate whether electroacupuncture (EA) can improve POCD by suppressing ferroptosis via the transferrin receptor 1 (TFR1)-divalent metal transporter 1 (DMT1)-ferroportin (FPN) pathway.

Methods: The experiment involved three groups: the control group, the POCD group and the POCD + EA group. The POCD animal model was established using sevoflurane anesthesia and tibial fracture. Cognitive and behavioral changes in mice were assessed using the novel object recognition test (NORT) and the Morris water maze (MWM) test, 1 and 3 days after surgery. Transmission electron microscopy was performed to observe changes in the mitochondrial structure of hippocampal tissue. Enzyme-linked immunosorbent assay was conducted to determine the levels of glutathione (GSH) and iron ion (Fe) concentrations. Western blot analysis was used to measure the expression of TFR1, DMT1 and iron pump protein. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was employed to detect the mRNA levels of DMT1 and FPN.

Results: Based on the experimental results of the MWM test and the NORT, we found that EA can improve POCD in mice. Observation by projection electron microscopy showed that EA improved the mitochondrial structure in the hippocampus. The enzyme-linked immunosorbent assay (ELISA) results showed that EA suppressed ferroptosis in the hippocampal area. The qRT-PCR and Western blot results suggested that EA suppresses ferroptosis by regulating the TFR1-DMT1-FPN pathway.

Conclusion: This study reveals that sevoflurane and tibial fractures cause cognitive damage through the mechanism of ferroptosis, while EA may inhibit ferroptosis through the TFR1-DMT1-FPN pathway and improve POCD when induced in this way.

Objective: Typically, neuropathic pain (NP) is difficult to manage as it is refractory to conventional medications. Electroacupuncture (EA) at 5/100 Hz has emerged as an effective and promising treatment for NP; however, its mechanism of action is still uncertain. Accordingly, this study investigated the alleviatory mechanism of EA in chronic compression injury (CCI)-induced chronic pain via the C-C chemokine ligand 3 / C-C chemokine receptor type 5 (CCL3/CCR5) axis.

Methods: The CCI model was established in rats to induce NP. Mechanical and thermal hyperalgesia were assessed with von Frey and Hargreaves tests, respectively. From day 8 after CCI, EA (5/100 Hz) was performed for 1 week (30 min/day). CCL3 and CCR5 expression was detected with Western blotting and immunofluorescence. Glial cell activation was determined through co-labeling of neurons and glial cells with antibodies against CCL3 and CCR5. The release of interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α was tested with enzyme-linked immunosorbent assay (ELISA).

Results: EA markedly ameliorated CCI-induced chronic NP in rats and reduced CCL3 and CCR5 expression in the rat spinal cord. CCL3 and CCR5 were co-expressed by neurons and microglia in the central nervous system. In addition, EA also repressed the activation of glial cells and levels of IL-1β, IL-6 and TNF-α.

Conclusion: EA may mitigate chronic NP in rats by blocking the CCL3/CCR5 axis in the spinal cord. In addition, EA appeared to exert anti-inflammatory and analgesic effects by suppressing glial cell activation. These findings add to our understanding of the mechanism of EA-induced analgesia.

Background: Acupuncture is an unusual cause of infectious sacroiliitis. Herein, we report three new cases of pyogenic sacroiliitis deemed to be attributable to acupuncture.Case 1:A 45-year-old male underwent 8 acupuncture sessions. He developed inflammatory pain in the left buttock, fever and tachycardia 11 days after the last session. Examination revealed involvement of the left sacroiliac joint. Magnetic resonance imaging (MRI) of the pelvis was consistent with sacroiliitis and blood cultures were positive for Staphylococcus aureus. The final diagnosis was left sacroiliitis caused by S. aureus. He was treated with lincomycin.Case 2:A 55-year-old female who had undergone 10 acupuncture sessions presented with inflammatory gluteal pain 10 days after the last session. Physical examination revealed signs of sacroiliac involvement, confirmed by MRI of the pelvis. The diagnosis was right sacroiliitis complicated by myositis of the gluteal muscles caused by S. aureus. Treatment consisted of antibiotic therapy with amoxicillin and ofloxacin.Case 3:A 72-year-old female who had undergone 10 acupuncture sessions presented 5 days after the last session for inflammatory gluteal pain. On examination, left unipodal weight-bearing was impossible and the tripod sign was present. MRI and clinical findings were in favor of left sacroiliitis associated with infectious pyogenic spondylodiscitis at L4-L5 and paravertebral abscesses. She received empiric antibiotic treatment with amoxicillin and gentamycin, followed by ofloxacin. On the 14th day, the patient unexpectedly died of pulmonary embolism after developing respiratory distress.

Conclusion: This case series highlights the continued need for vigilance in the clinical practice of acupuncture.

Objective: The aim of this study was to determine the impact of electro-acupuncture (EA) pretreatment on the progression of acute gastric mucosal lesions (AGMLs) induced by water immersion restraint stress (WIRS) and explore the related mechanisms including the transient receptor potential vanilloid (TRPV)1 signaling pathways.

Methods: Rats treated with EA for 4 days were subjected to WIRS for 6 h. Microscopic lesions, oxidative stress and TRPV1, substance P (SP), calcitonin gene-related peptide (CGRP) and nitric oxide (NO) levels in the dorsal root ganglion (DRG) and gastric tissues were detected.

Results: The results indicated the development of AGMLs with a substantial increase of TRPV1/SP in the DRG and TRPV1/SP/MDA (malondialdehyde activity) in the stomach, and a significant decrease in CGRP/NO/SOD (superoxide dismutase) in gastric tissues, using a combination of real-time reverse transcription polymerase chain reaction, Western blotting and enzyme-linked immunosorbent assay.

Conclusion: The TRPV1 signaling pathways likely play an important role in the pathogenesis of AGML. In addition, EA pretreatment protected gastric mucosa lesions induced by WIRS by reducing the expression of TRPV1/SP in the DRG and gastric mucosa, as well as up-regulating gastric CGRP/NO. Antioxidant mechanisms are likely to at least partially mediate the protective effects of EA against AGML.

Objective: Our previous study found that astrocytes are involved in cumulative analgesia; however, the underlying mechanism remains unclear. The aim of this study was to further explore the potential role of astrocytes in the effects of electroacupuncture (EA) on neuropathic pain by focusing on the glutamate-glutamine cycle.

Methods: 69 male Sprague-Dawley (SD) rats were randomly divided into a normal control group, untreated chronic constriction injury (CCI) model group and EA-treated model (CCI + EA) group. EA was applied bilaterally at ST36 and GB34. Pain thresholds were assessed using behavioral tests and thermal stimuli. We examined the co-expression of glutamate/aspartate transporter (GLAST) via immunofluorescence and measured the expression levels of GLAST, glutamate transporter (GLT)-1 and glutamine synthetase (GS) using Western blotting and polymerase chain reaction (PCR). Glutamate (Glu) and gamma-aminobutyric acid (GABA) levels were detected by high-performance liquid chromatography (HPLC). To validate the impact of GLAST/GLT-1 in the analgesic effect of EA, an additional 30 SD male rats were divided into groups receiving intrathecal saline, GLAST antagonist or GLT-1 antagonist alongside EA.

Results: Post-CCI, pain thresholds were decreased, GLAST expression was diminished, and spinal Glu levels were increased. EA treatment reversed these effects, improved pain thresholds and GLAST/GLT-1 expression in astrocytes, and reduced Glu levels. Antagonist administration negated the analgesic effects of EA.

Conclusion: Repeated EA administration inhibited CCI-induced chronic neuropathic pain in rats, corresponding to a reversal of decreased expression of GLAST and GLT-1, which may have accelerated the clearance of Glu and thereby reduced its concentration. Regulation of the astroglial glutamate-glutamine cycle is a potential target of EA.

Objective: Cognitive impairment (CI) is highly prevalent in subarachnoid hemorrhage (SAH) patients. The phosphatidylinositol 3-kinase (PI3K)/AKT pathway plays a critical role in neuronal survival in a variety of central nervous system injuries. This study aimed to determine whether electroacupuncture (EA) at Yintang and LI20 ameliorates SAH-CI in a rat model and to examine whether it modulates the PI3K/AKT pathway by administering a PI3K inhibitor (LY294002) versus dimethyl sulfoxide (DMSO) vehicle.

Methods: Notably, 129 male Sprague-Dawley rats were divided into Blank, Sham, SAH and SAH + EA groups (Experiment 1, n = 54) and SAH, SAH + EA, SAH + LY294002, SAH + EA + LY294002 and SAH + EA + DMSO groups (Experiment 2, n = 75). Garcia scoring was used to evaluate neurological function. The moisture content of the rat brain was determined by dry‒wet method. The Morris water maze was used to assess learning and memory function. Pathological changes in neurons in the hippocampus were observed via hematoxylin-eosin (H&E) staining. The number of surviving neurons and the percentage of apoptotic cells in the hippocampus were detected via Nissl and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining. The expression of PI3K/AKT pathway-related proteins was detected via Western blotting.

Results: The results indicated that EA intervention after SAH reduced brain water content, enhanced Garcia scores, improved neurological function and behavioral markers of CI, and increased the number of surviving neurons in the hippocampus. Moreover, EA significantly increased the expression of AKT, phosphorylated (p)-AKT, PI3K, p-PI3K, glycogen synthase kinase (GSK)-3β, p-GSK-3β and B cell lymphoma (Bcl)-2 proteins, and decreased the expression of Bcl-2-associated X (Bax) and caspase-3. In addition, the effects of EA were abolished by LY294002.

Conclusion: EA appeared to improve CI in a rat model of SAH through the activation of the PI3K/AKT pathway.

Background: Although growing numbers of patients seek acupuncture for pain management, few acupuncturists with insurance credentialing work in the conventional medical settings. This has resulted in increasing frustration among patients wishing to receive acupuncture in primary care settings as part of their insurance benefits.

Methods: A course of eight weekly sessions of group auricular acupuncture (AA) for chronic musculoskeletal pain was implemented in a US primary care clinic and billed to insurance. The process of implementing group AA is described, including patients and researchers' perceptions of their experience. We also examined various hypothetical scenarios for reimbursement based on relative value units (RVUs) based on Centers for Medicare and Medicaid (CMS) billing/coding.

Results: Recruitment was greatly limited by COVID-19 requirements for social distancing and administrative hurdles, such that only four patients participated, three of whom attended all eight sessions. Seven additional Medicare patients were excluded due to concerns that acupuncture would not be covered. Participants reported mostly positive experiences with both AA and the group model of care. Based on our hypothetical reimbursement scenarios, in the fee-for-service model, group sessions appear to be economically more viable when staffed by non-physician acupuncturists credentialed for insurance reimbursement. For example, for a group of six patients each receiving acupuncture would be anticipated to generate 3.60 RVUs, whereas a physician seeing three individual patients consecutively for return office visits at CMS Evaluation and Management (E/M) level 3 could generate at least 4.11 RVUs.

Conclusions: Offering group AA services in primary care clinics might increase access to acupuncture for patients with chronic pain. Although patients appreciated quicker access to acupuncture through group visits, and the group visit experience itself, logistical and economic barriers remain a challenge for sustainable group-based acupuncture visits.